Analysis of the implementation of GESIDA quality indicators in the HIV+ cohort PSITAR

Objective: To determine the compliance of quality care indicators (GESIDA) for adult patients living with HIV infection in PSITAR cohort. Methods: Multi-center, prospective observational study. All adult naive patients, that began treatment during 2011 belonging to the PSITAR cohort, were selected. We recorded demographic data, virological parameters at baseline and 48 weeks of treatment and pharmacotherapy variables. The selected indicators were: The compliance of initial antiretroviral therapy with the Spanish national treatment guidelines (GESIDA) for treatment-naive HIV-infected patient (95%), undetectable viral load at 48 weeks (80%), treatment initiation with Abacavir without screening for HLA-B*5701 (0%), treatment modifications within the first year (<30%), adherence treatment measure (95%), study of resistance in the virologic failure (90%) and average expenditure per patient in the first treatment (GESIDA median). Results: In total 108 HIV+ naive patients were included, 83.3% men. The median age was 40.5 years (21-75). The most frequent combination was tenofovir-emtricitabineefavirenz with 61.0%. 28 patients (29.7%) modified their treatment during the first year. Focusing on indicators compliance, starting of treatment with a recommended regimen had 95.4% of compliance, undetectable viral load indicator 74.1%, treatment initiation without Abacavir test 0%, treatment modifications within the first year 25.9%, adherence treatment measure 86.3%, study of resistance in the virologic failure 80% and average expenditure per patient was 8,846 euros. Conclusion: Quality care follow up indicators were fulfilled in their vast majority. The worst accomplished indicators such as undetectable viral load at 48 weeks, evaluation of adherence and study of resistance must be study to examine the possible improvement points.Objetivos: Determinar el cumplimiento de los indicadores de calidad de la actividad asistencial GESIDA en la cohorte de pacientes VIH+ PSITAR. Método: Estudio multicéntrico prospectivo. Se seleccionaron aquellos pacientes VIH naive adulto que iniciaron tratamiento en 2011. Se recogieron variables demográficas, analíticas y farmacoterapéuticas. Los indicadores seleccionados fueron: adecuación de las pautas iniciales de TAR a las guías españolas (95%), carga viral indetectable al año de tratamiento (80%), tratamiento con abacavir sin HLA-B*5701 previo (0%), cambios de tratamiento durante el primer año (<30%), registro de la adherencia al tratamiento (95%), estudio de resistencias en el fracaso virológico (90%) y gasto medio por paciente en primer tratamiento (mediana GESIDA). Resultados: Se incluyeron 108 pacientes, de ellos el 83,3% hombres. La mediana de edad fue de 40,5 años (21-75). La combinación de inicio más frecuente fue emtricitabina-tenofovir-efavirenz (61%). El 95,4% de los pacientes iniciaron con un tratamiento considerado preferente. El 74,1% presentó carga viral plasmática indetectable a las 48 semanas. Ningún paciente inicio tratamiento con abacavir sin la determinación del HLA-B*5701. El 25,9% discontinuó el TAR en el primer año, registrándose una valoración de la adherencia en el 86,3% de los casos. El estudio de las resistencias en fallo virológico se realizó en el 80,0% de los pacientes y el gasto medio fue de 8.846 euros. Conclusiones: Los indicadores de calidad de la actividad asistencial se cumplen ampliamente. La carga viral plasmática indetectable, la valoración de la adherencia y el estudio de resistencia requieren de un mayor estudio para detectar puntos de mejora

Case report: Self-administration of alpha-1 antitrypsin therapy: a report of two cases

Intravenous augmentation therapy with human alpha-1 proteinase inhibitor for the management of respiratory disease is recommended for people with alpha-1 antitrypsin deficiency (AATD) who are nonsmokers or former smokers. Augmentation therapy usually requires weekly administration at the hospital or clinic and poses an additional burden for patients due to interference with daily life, including work and social activities. Self-administration is a useful alternative to overcome this limitation, but there is a lack of published information on clinical outcomes. We report two cases of individuals with AATD at different stages of the disease who were successfully managed with self-administered augmentation therapy, with increased satisfaction because of the independence gained, lack of interference with clinical stability, and no relevant safety issues

High output stoma: detection and approach

La ostomía de alto débito es una complicación frecuente en pacientes portadores de ileostomías que está poco identificada y que no suele ser adecuadamente abordada desde el punto de vista clínico. No está descrita de manera consensuada, pudiendo variar entre débitos de 2.000 ml en 24h o alrededor de 1.500 ml en durante 3-5 días, según los autores. Suele presentar graves consecuencias para el paciente tanto a corto como a largo plazo y está asociada a reingresos. Se presenta una revisión de la literatura publicada al respecto sobre los factores relacionados con la resección quirúrgica que influyen en una posterior aparición de esta complicación, las causas que intervienen en su desarrollo, la necesidad de establecer un concepto objetivo y claro de alto débito así como las implicaciones negativas presenta. Así mismo se recoge como debe realizarse el manejo de estos pacientes con respecto al tratamiento y abordaje nutricional.High output stoma is a frequent complication in patients with ileostomies that is not well identified and is not often properly addressed by clinicians. It has not been described properly, and can vary between debits of 2.000ml in 24 h to 1.500 ml in 3-5 days, according to different authors. Frequently presents both short-term and long-term negative implications for patients and is associated with readmissions. We present a review of published literature focusing in surgical resection-related factors that influence a later appearance of this complication, causes involved in its development, the need to establish a clear and objective concept of high ouput as well as the negative implications it presents. Also we develop how should we the management of these patients regarding treatment and nutritional approach

Impact of a nutrition consultation on the rate of high output stoma‑related readmission: an ambispective cohort study

We thank the staff of the Pharmacy and Nutrition Department at the Costa del Sol Hospital. The present study is part of a Pharmacy PhD research programme being conducted at the University of Granada.The aims of this study were to assess the impact of a follow-up nutrition consultation for ostomy patients on the rate of high output stoma (HOS)-related readmissions, as well as on the detection of poor nutritional status and their management, and to determine the associated economic impact. A single-centre ambispective cohort study was conducted in which all adult patients undergoing intestinal resection and stoma creation were recruited. Two nutrition consultations were established for early follow-up after hospital discharge and patients were prospectively included. Additionally, a retrospective search was carried out to include a control group. In both groups, a 12-month follow-up was conducted to record readmissions associated with high output stoma. A multivariate logistic regression was performed. Statistical significance level was established at p < 0.05. 170 patients were recruited, 85 patients in each cohort. Demographic data and clinical characteristics were recorded. A significant difference was observed in HOS-related readmissions, with readmission rates of 28.6% vs 10.3% in the retrospective and prospective cohort, respectively. At the first follow-up consultation, 50.5% of patients presented some degree of protein-calorie malnutrition. A statistically significant improvement in nutritional status was observed in the second evaluation. The intervention carried out resulted in a total saving of €24,175. Early follow-up of patients after discharge resulted in a significant reduction in the rate of HOS-related readmissions and allowed to identify a high percentage of patients with malnutrition. The cost analysis showed the process to be a cost-effective improvement

Survey on the situation of telepharmacy as applied to the outpatient care in hospital pharmacy departments in Spain during the COVID-19 pandemic

Objective: To analyze the status of the implementation and development of telepharmacy as applied to the pharmaceutical care of outpatients treated at hospital pharmacy services in Spain during the COVID-19 pandemic. Method: Six weeks after the beginning of the confinement period, an online 10- question survey was sent to all members of the Spanish Society of Hospital Pharmacists. A single response per hospital was requested. The survey included questions on the provision of remote pharmaceutical care prior to the onset of the health crisis, patient selection criteria, procedures for home delivery of medications and the means used to deliver them, the number of patients who benefited from telepharmacy, and the number of referrals made. Finally, respondents were asked whether a teleconsultation was carried out before sending patients their medication and whether these deliveries were recorded. Results: A total of 39.3% (n = 185) of all the hospitals in the National Health System (covering all of Spain's autonomous regions) responded to the survey. Before the beginning of the crisis, 83.2% (n = 154) of hospital pharmacy services did not carry out remote pharmaceutical care activities that included telepharmacy with remote delivery of medication. During the study period, 119,972 patients were treated, with 134,142 deliveries of medication being completed. Most hospitals did not use patient selection criteria. A total of 30.2% of hospitals selected patients based on their personal circumstances. Home delivery and informed delivery (87%; 116,129 deliveries) was the option used in most cases. The means used to deliver the medication mainly included the use of external courier services (47.0%; 87 hospitals) or the hospital's own transport services (38.4%; 71 hospitals). As many as 87.6% of hospitals carried out teleconsultations prior to sending out medications and 59.6% recorded their telepharmacy activities in the hospital pharmacy appointments record. Conclusions: The rate of implementation of telepharmacy in outpatient care in Spain during the study period in the pandemic was high. This made it possible to guarantee the continuity of care for a large number of patients.YesObjetivo: Analizar la situación de la implantación y desarrollo de la telefarmacia aplicada a la atención farmacéutica a pacientes externos de los servicios de farmacia hospitalaria en España durante la pandemia por la COVID-19.Método: Se envió una encuesta online de 10 preguntas a todos los socios de la Sociedad Española de Farmacia Hospitalaria a las seis semanas del inicio del periodo de confinamiento por la pandemia. Se solicitó una única respuesta por hospital. Se incluyeron preguntas sobre la realización de atención farmacéutica no presencial con dispensación a distancia previa al inicio de la crisis sanitaria, los criterios de selección de pacientes, los procedimientos de envío de medicación y los medios utilizados, el número de pacientes que se han beneficiado de la telefarmacia y el número de envíos realizados. Por último, se identificó la realización o no de teleconsulta previa al envío de medicación y si la actividad quedó registrada.Resultados: Un 39,3% (n = 185) del total de hospitales públicos del Sistema Nacional de Salud pertenecientes a todas las comunidades autónomas respondieron a la encuesta. El 83,2% (n = 154) de los servicios de farmacia hospitalarios no realizaban actividades de atención farmacéutica no presencial con telefarmacia que incluyeran envío de medicación antes del inicio de la crisis sanitaria. En el periodo de estudio se atendieron 119.972 pacientes y se realizaron 134.142 envíos de medicación. La mayoría de los hospitales no utilizaron criterios de selección de pacientes. El 30,2% de los centros seleccionaron en función de las circunstancias personales del paciente. La dispensación domiciliaria y entrega informada (87%; 116.129 envíos) fue la opción utilizada de forma mayoritaria para el envío. Los medios para hacer llegar la medicación fueron, principalmente, la mensajería externa (47%; 87 centros) o medios propios del hospital (38,4%; 71 centros). Un 87,6% de los hospitales realizaron teleconsulta previa al envío de medicación y el 59,6% registró la actividad de telefarmacia en la agenda de citación. Conclusiones: La implantación de la telefarmacia aplicada a la atención a pacientes externos en España durante la pandemia ha sido elevada. Así se ha podido garantizar la continuidad de los tratamientos de un elevado número de pacientes

Evaluation of a protocol to detect malnutrition and provide nutritional care for cancer patients undergoing chemotherapy.

Patients with cancer frequently experience malnutrition, which is associated with higher rates of morbidity and mortality. Therefore, the implementation of strategies for its early detection and for intervention should improve the evolution of these patients. Our study aim is to design and implement a protocol for outpatients starting chemotherapy, by means of which any malnutrition can be identified and treated at an early stage. Before starting chemotherapy for patients with cancer, a complete assessment was made of their nutritional status, using the Nutriscore screening tool. When nutritional risk was detected, an interventional protocol was applied. Of 234 patients included in the study group, 84 (36%) required an individualised nutritional approach: 27 (32.1%) presented high nutritional risk, 12 had a Nutriscore result ≥ 5 and 45 experienced weight loss during chemotherapy. Among this population, the mean weight loss (with respect to normal weight) on inclusion in the study was - 3.6% ± 8.2. By the end of the chemotherapy, the mean weight gain was 0% ± 7.3 (p

Evaluación de la importancia de la comprensión de las recomendaciones dietéticas y de estilo de vida en los pacientes con ostomía

Objective: the objective of our study was to evaluate the level of understanding of ostomy patients regarding lifestyle, diet, and high output stoma (HOS) management recommendations provided by healthcare professionals. Method: a prospective study to follow up ostomy patients at nutritional consultations was designed. The follow-up process was performed 7-10 days after hospital discharge and again one month later. At the first visit, patients were instructed in the detection and management of HOS. At the second visit, the level of understanding of the training received was assessed using an evaluation questionnaire. A descriptive analysis of the answers to each of the questionnaire’s items was performed. Fisher’s exact test was used to evaluate differences in the level of understanding recorded with the questionnaire. Results: a total of 35 patients were recruited; 71.4 % did not provide correct answers to all the questions. There were no significant differences in the correctness of the answers to the questionnaire according to education level. Conclusions: many patients do not adequately understand the information provided by healthcare professionals and this could have a negative impact on the incidence of clinical complications.Objetivo: el objetivo de nuestro estudio fue evaluar el nivel de comprensión de los pacientes ostomizados con respecto a las recomendaciones sobre estilo de vida, dieta y manejo de la ostomía de alto débito (OAD) proporcionadas por los profesionales de la salud. Método: se diseñó un estudio prospectivo para el seguimiento de pacientes ostomizados en consulta de nutrición. El seguimiento se realizó 7-10 días después del alta hospitalaria y a continuación un mes después. En la primera visita, se instruyó a los pacientes sobre la detección y el tratamiento de OAD. En la segunda visita se evaluó el nivel de comprensión de la formación recibida mediante un cuestionario de evaluación. Se registraron las respuestas dadas a cada uno de los ítems del cuestionario y se realizó un análisis descriptivo. Para evaluar las diferencias en el nivel de comprensión registrado con el cuestionario se utilizó la prueba exacta de Fisher. Resultados: se reclutaron 35 pacientes. El 71,4 % no respondieron correctamente a todas las preguntas. La exactitud de las respuestas al cuestionario no mostró diferencias significativas según el nivel educativo. Conclusiones: un gran número de pacientes no comprende adecuadamen